What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?
What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?
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DOI：
10.1097/ccm.0b013e31823bc8bb
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发表时间：
2012-04
影响因子：
8.8
通讯作者：
Resuscitation Outcomes Consortium (ROC) Investigators
中科院分区：
文献类型：
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作者：
Stiell IG;Brown SP;Christenson J;Cheskes S;Nichol G;Powell J;Bigham B;Morrison LJ;Larsen J;Hess E;Vaillancourt C;Davis DP;Callaway CW;Resuscitation Outcomes Consortium (ROC) Investigators
2010年国际心肺复苏术指南最近建议将最小按压深度从38 mm增加到50 mm，尽管支持这一点的人体数据有限。我们试图研究CPR按压深度的模式及其与2005年指南标准治疗的院外心脏骤停（OOHCA）病例的患者结局的相关性。我们研究了2006年5月至2009年6月期间，来自复苏结局联盟Epistry -心脏骤停的接受紧急医疗服务治疗的OOHCA患者，这些患者的电子CPR按压深度数据可用。我们计算了以毫米为单位的前胸壁凹陷和每分钟CPR的主动CPR时间（胸部按压分数）。我们控制了包括压迫率在内的协变量，并计算了任何自主循环恢复（ROSC）、1天生存率和出院率的校正比值比。我们纳入了来自美国和加拿大7个城市的1，029名成年患者，这些患者具有以下特征：平均年龄68岁;男性62%;旁观者见证40%;旁观者CPR 37%;初始心律- VF/VT 24%，PEA 16%，心搏停止48%，其他非电击12%;结局- ROSC 26%，1天生存率18%，出院5%。所有患者的平均压迫率为每分钟106次，平均压迫分数为0.65，平均压迫深度为37.3 mm，52.8%的患者深度< 38 mm，91.6%的患者深度< 50 mm。我们发现深度与压迫率呈负相关（P<0.001）。所有深度指标（平均值、类别和范围内）的调整优势比显示，随着所有三种生存指标的深度增加，结局更好的趋势很强。我们发现，根据2005年指南标准，一半患者的按压深度不理想，根据2010年标准，几乎所有患者的按压深度都不理想，按压深度和速率之间呈负相关。我们发现生存结果与按压深度增加之间存在很强的相关性，但没有明确的证据支持或反驳2010年推荐的> 50 mm。虽然按压深度是CPR的重要组成部分，应定期测量，但目前尚不清楚最有效的深度。
The 2010 international guidelines for CPR recently recommended an increase in the minimum compression depth from 38 to 50 mm, although there are limited human data to support this. We sought to study patterns of CPR compression depth and their associations with patient outcomes in out-of-hospital cardiac arrest (OOHCA) cases treated by the 2005 guideline standards. We studied emergency medical services treated OOHCA patients from the Resuscitation Outcomes Consortium Epistry - Cardiac Arrest for whom electronic CPR compression depth data were available, from May 2006 to June 2009. We calculated anterior chest wall depression in millimeters and the period of active CPR (chest compression fraction) for each minute of CPR. We controlled for covariates including compression rate and calculated adjusted odds ratios for any return of spontaneous circulation (ROSC), 1-day survival, and hospital discharge. We included 1,029 adult patients from 7 U.S. and Canadian cities with these characteristics: mean age 68 years; male 62 %; bystander witnessed 40%; bystander CPR 37%; initial rhythms - VF/VT 24%, PEA 16%, asystole 48%, other non-shockable 12%; outcomes - ROSC 26%, 1-day survival 18%, discharge 5%. For all patients, median compression rate was 106 per minute, median compression fraction 0.65, and median compression depth 37.3 mm with 52.8% of cases having depth < 38 mm and 91.6% having depth < 50 mm. We found an inverse association between depth and compression rate (P<0.001). Adjusted odds ratios for all depth measures (mean values, categories, and in range) showed strong trends towards better outcomes with increased depth for all three survival measures. We found suboptimal compression depth in half of patients by 2005 guideline standards and almost all by 2010 standards, as well as an inverse association between compression depth and rate. We found a strong association between survival outcomes and increased compression depth but no clear evidence to support or refute the 2010 recommendations of > 50 mm. While compression depth is an important component of CPR and should be measured routinely, the most effective depth is currently unknown.